MBS item numbers for vitamin B12 testing

Before November 2014, vitamin B12 and folate tests were linked in the same MBS item numbers (66599 and 66602) and could be used singularly or together to find vitamin deficiency. Linking these tests resulted in difficulty identifying which test or tests were being ordered at an individual patient level
and may have led to over-ordering.
2

To encourage the quality use of testing under Medicare, vitamin B12 and serum folate are now listed as separate items.2 The following item numbers need to be used when investigating B12 levels.4

Item

Item description

66838

Serum vitamin B12 test (item is subject to rule 25*)

66839

Quantification of vitamin B12 markers such as holotranscobalamin or methylmalonic acid, where initial serum vitamin B12 result is low or equivocal†

* Rule 25: For any particular patient, this item is applicable not more than once in a 12-month period

† Check with laboratory pathologist to determine if this test is clinically warranted. Laboratories will perform serum B12 when indicated and when the result is ‘low’ or ‘equivocal’ (ie, not clearly replete and not clearly deficient) the laboratory pathologist can determine
if holotranscobalamin or methylmalonic acid is required as a reflex test

Who requires vitamin B12 testing?

The MBS review did not identify any prospective studies that evaluated the clinical indications for vitamin B12 testing.2 However, several guidelines recommend testing vitamin B12 levels to investigate the following clinical indications:

Who requires folate testing?

The MBS review did not identify any prospective trials that evaluate the clinical indications for folate testing.1

With the introduction of mandatory folate fortification of wheat flour for bread-making in Australia, folate deficiency is now very rare.16, 17 However, folate deficiency may still occur in some people because of inadequate nutritional intake caused by poor diet,
alcoholism, increased requirements such as in pregnancy and lactation, and impaired absorption and intake, for example, coeliac disease.
18, 19

Folate testing is not required to inform folate supplementation before and during pregnancy. All women should be given folic acid supplements prophylactically (0.5 mg/day, or 5 mg/day if at high risk of having babies with neural tube defects) for 1 month before conception and for the
first trimester.
20

MBS item number for vitamin D testing

The MBS review of vitamin D testing noted a substantial increase in the number of claims for vitamin D testing over the past 10 years and concluded that most of these services are being requested for the purposes of screening or testing, rather than follow-up monitoring.3

To encourage the quality use of testing under Medicare, vitamin D testing has been split into two types:3

The following item numbers will need to be used when investigating vitamin D levels.4

Item

Item description

66833

25-hydroxyvitamin D, quantification in serum, for the investigation of a patient who:(a) has signs or symptoms of osteoporosis or osteomalacia; or(b) has increased alkaline phosphatase and otherwise normal liver function tests; or(c) has hyperparathyroidism, hypo- or hypercalcaemia, or hypophosphataemia; or(d) is suffering from malabsorption (for example, because
the patient has cystic fibrosis, short bowel syndrome, inflammatory bowel disease or untreated coeliac disease, or has had bariatric surgery); or
(e) has deeply pigmented skin, or chronic and severe lack of sun exposure for cultural, medical, occupational or residential reasons; or(f) is taking
medication known to decrease 25OH-D levels (for example, anticonvulsants); or
(g) has chronic renal failure or is a renal transplant recipient; or(h) is less than 16 years of age and has signs or symptoms of rickets; or(i) is an infant whose mother has established vitamin D deficiency;
or
(j) is a exclusively breastfed baby and has at least one other risk factor mentioned in a paragraph in this item; or(k) has a sibling who is less than 16 years of age and has vitamin D deficiency

66834

A test described in item 66833 if rendered by a receiving Approved Pathology Practitioner

(Item is subject to Rule 18*)

66835

1, 25-dihydroxyvitamin D – quantification in serum, if the request for the test is made by, or on advice of, the specialist or consultant physician managing the treatment of the patient

66836

1, 25-dihydroxyvitamin D – quantification in serum, if:(a) the patient has hypercalcaemia; and(b) the request for the test is made by a general practitioner managing the treatment of the patient

66837

A test described in item 66835 or 66836 if rendered by a receiving Approved Pathology Practitioner (Item is subject to Rule 18*)

* Rule 18: an arrangement under which Medicare benefits payable in a patient episode for a set of pathology services containing more than three items, ordered by a general practitioner for a non-hospitalised patient, will be equivalent to the sum of the benefits for the three items with the highest
Schedule fees.

Who requires vitamin D testing?

Only patients listed in the MBS item descriptors should be tested. Guidelines recommend testing people with signs and symptoms of vitamin D deficiency and populations at high risk of moderate to severe vitamin D deficiency.21, 22

Data from two studies indicate that only 4% of Australians have moderate to severe vitamin D deficiency (serum 25-hydroxyvitamin D levels < 25 nmol/L).23, 24 Use of vitamin D testing for screening in healthy and low-risk populations is not necessary.21, 22

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Date published: 29 September 2015Reasonable care is taken to provide accurate information at the time of creation. This information is not intended as a substitute for medical advice and should not be exclusively relied on to manage or diagnose a medical condition. NPS MedicineWise disclaims all liability (including for negligence) for any loss, damage or injury resulting from reliance on or use of this information. Read our full disclaimer. This website uses cookies. Read our privacy policy.